Varizen tubal

Varizen tubal



Varizen tubal

The present application is a continuation of application Ser. Chin, now abandoned, which is a continuation-in-part application of application Ser. This invention relates to a cannula used for vessel retraction, Varizen tubal, and more particularly to a cannula and method for retracting a vessel during dissection and transection.

One important component of a surgical cannula is the tip, disposed on the distal end of the cannula. A properly configured Varizen tubal can provide important functionality to a cannula. For example, the functions of vessel dissection and transection are commonly performed by two separate instruments.

The device described in the pending application Ser. It is desirable to use a single device for performing the above functions. The construction of a cannula tip also affects the visual field provided to a surgeon through an endoscope. When an endoscope is situated in a lumen of the cannula, the surgeon looks through the endoscope and through the transparent tip to view the surgical site, Varizen tubal.

It is desirable to have a tip which maximizes the visual field of the endoscope. The cannula tip may also be used to dilate a tunnel Varizen tubal anatomical Varizen tubal through tissue planes.

In pending application Ser. Cannula tips for dilating tunnels through tissue require force in order to advance the cannula and dilate the tissue, Varizen tubal. It Krampfadern in den Beinen und Juckreiz desirable to have a tip which can perform tissue dilation or dissection using a minimal amount of force and causing minimal trauma.

In accordance with the present invention, a tissue retractor is positioned within a cannula with a dissection cradle end of the retractor positioned at the distal end of the cannula, Varizen tubal.

The retractor includes a first portion that has an axis approximately parallel to a central axis of the cannula, and a second portion that has an axis which is at an angle with respect to the central axis of Varizen tubal cannula, Varizen tubal. The dissection cradle is located at the distal end of the second portion of the retractor.

In another embodiment, the retractor includes two legs having substantially parallel axes that selectively protrude from the distal Varizen tubal of the cannula. The protruding legs support the dissection cradle formed in the shape of a loop that is positioned in a plane skewed relative to the axes of the legs, with a bottom of the loop directed away from the cannula.

Thus, in operation, when the surgeon locates a vein Varizen tubal side branch of interest, the surgeon extends the retractor to cradle the vein in the dissection cradle, Varizen tubal. Once cradled, the retractor may be fully extended to urge the vein away from the axis of the cannula, causing the side branch to be isolated and exposed to a surgical tool.

The surgical tool may then be extended from within the cannula to operate on the isolated and exposed side branch, Varizen tubal. In another embodiment, the top of the loop of Varizen tubal dissection cradle is flat and thin, allowing atraumatic support of the vein, and minimizing contact between the retractor and the surgical tool.

In yet a further embodiment, the retractor includes a single leg with the loop formed by the one leg of the retractor, and with a stopper coupled to the distal end of the retractor.

In still another embodiment, the cannula comprises a sliding tube which encases the retractor, Varizen tubal, and in a first position is extended out to encase the second portion of the retractor, and in a second position is extended to encase only the first portion of the retractor. In response to the sliding tube being in the first position, the second and first portions of the retractor are both approximately parallel to the axis of the cannula.

In response to the sliding Varizen tubal being in the second position, the second portion of the retractor is skewed relative to the axis of the cannula. In accordance Varizen tubal an alternate embodiment Varizen tubal the present invention, a removable, transparent tip is positioned at the distal end of the cannula to provide a single cannula for performing dissection and transection. When attached, Varizen tubal, the tip seals the distal end of the cannula in a fluid resistant manner.

The tip is conical and ends in a sharp interior point and a slightly rounded exterior point which allows the surgeon to bluntly dissect tissue in the area of interest under endoscopic visualization. When tissue dissection is complete, Varizen tubal, the surgeon can remove the tip from the cannula, and the surgeon is now able to use Varizen tubal cannula to transect side Varizen tubal and vessel ends.

In order to maximize the visual field provided by the endoscope, the tip is configured to allow the apex of the tip to be aligned with the central axis of the endoscope, Varizen tubal. In one embodiment, Varizen tubal, a distal end of the Becken- Varizen Prüfung is tilted in an oblique fashion to allow Varizen tubal apex of the tip to align with or near to the central axis of the endoscope, Varizen tubal.

In an alternate embodiment, the conical end of the tip has unequal taper angles relative to a plane of transition between the cylindrical and conical portions of the tip, thus skewing the position of the apex of the tip into alignment with or near to the central axis of the endoscope, Varizen tubal. In another embodiment, wing-like protrusions are provided about the cannula near the tip to dilate tissue surrounding the vessel of interest.

In one embodiment, the wing-like protrusions are diametrically aligned in a planar configuration with tapered forward edges extending rearward from near the apex of the tip. The planar configuration of the wing-like dilating protrusions near the tip substantially reduces the resistive force encountered during advancement of the cannula through tissue. The Varizen tubal protrusions are positioned on opposite sides of the tip to dissect tissue to form a cavity that may attain a round cross-section under insufflation, thus providing the same resultant tissue dilation as provided by a solid oval dilator, but with less force required to accomplish the tissue dilation.

In an alternate embodiment, the leading edges of the wing-like protrusions are curved in a parabolic configuration away from the distal end of the cannula to provide the necessary dilation. The proximal end of the cannula is disposed in handle that includes a button which is coupled to retractor for controlling the translational movement of retractorVarizen tubal, as described in more detail below. Varizen tubal distal end of the cannula houses a retractorand optionally an endoscope and a surgical tooldescribed below.

In one embodiment, retractor is formed of resilient wire which has a smooth bend intermediate to a first portion and a second portion of the retractor. The retractor is described as having two portions for ease of description, Varizen tubal, although the retractor may be formed as an integrated structure.

However, retractor may also be manufactured from two separate portionsthat are coupled together, Varizen tubal. The first portion of the retractor is positioned within the cannula with the axis of the first portion Varizen tubal parallel to the axis of the cannula The second portion is positioned to bend away from the central axis of the cannula. The angle of displacement between the axis of Varizen tubal second portion and the central axis of cannula may be any angle from zero to degrees.

The second portion includes a dissection cradle at the distal end of the second portion The retractor may be formed of bioinert material such as stainless steel, or a polymer such as nylon or polyetherimide, or other appropriately strong and resilient Varizen tubal. In one embodiment, the retractor includes a coating for lubrication, insulation, and low visual glare using, for example, parylene or nylon The top portion of the U-shaped bend is preferably Varizen tubal to provide additional surface area for atraumatically supporting a vein or vessel of Varizen tubal. The side arches of the dissection cradle are used for skeletonizing or dissecting the vein from the surrounding tissues, as well as acting as walls to keep the Varizen tubal captured within the arch.

The several embodiments of dissection cradle are described in more detail below. The Varizen tubal is positioned within the side arches of the cradle The dissection cradle may be used to cradle a vein, vessel, tissue or organ Varizen tubal interest, and surgical tool may be any surgical tool suitable for performing a surgical procedure Varizen tubal the dissection cradle In this embodiment, cradle preferably overlays the endoscope with sufficient clearance to facilitate relative movements thereof.

However, the endoscope may also be located adjacent the surgical tool In one embodiment, endoscope is positioned with cannula to allow a clear field of view upon extension of Varizen tubal retractor Surgical tool is illustrated as cauterizing scissors, used to sever a tributary or side branch of a sapphenous vein In this embodiment, surgical tool is maximally displaced from the cradle at the cannula end More specifically, as shown in FIG, Varizen tubal.

This ensures that a vein or other tissue of interest is retracted away from the surgical tool to facilitate manipulating the surgical tool relative to the side branch or other tissue. The retractor is slidably positioned within minor lumens along the length of the cannula within close tolerances in order to position the retractor stably within the cannula For example, in one embodiment retractor legsVarizen tubal, Varizen tubal approximately 0.

This configuration restricts rotational movement of the retractor to provide more Varizen tubal retraction as compared with conventional retractors. The legsof the retractor are formed of flexible, resilient material and are retained within the lumen in substantially straight or flat orientation, but may return to a material bend or curve, as illustrated in FIG, Varizen tubal.

The leg of the retractor passes through a sliding gas or fluid seal at the proximal end of the lumen Varizen tubal leg of the retractor passes out of the cannula and into handle for attachment to a slider button for facilitating translational movement of the retractor from the proximal or handle end of the cannula However, other types of control devices such as knobs, grips, finger pads, and the like may be linked in conventional ways to the retractor in order to manually control the translational movement of retractor In one configuration, the proximal end of leg is bent relative to the axis of the cannula, and the button is attached to the bent position of the leg to facilitate moving the button and the retractor translationally under manual control.

The button preferably includes lateral grooves to prevent finger or thumb slippage during sliding manipulation of the retractor Thus, in the operation of a preferred embodiment, a user actuates the slider button to extend retractor out of the lumen at the distal end of the cannula In one embodiment, the resilient retractor is formed in a smooth bend, Varizen tubal, as shown in FIG.

Upon encountering the target vessel Varizen tubal tissue of interest, the vessel is restrained in the cradleand a lateral resilient force is exerted on the target vessel in a direction away from the cannula. The vessel is thus pushed away from the axis of the cannulaisolating it from surrounding tissue or adjacent vessels such as tributaries or side branches.

As a tributary is thus isolated, a surgical tool such as cauterizing scissors may be safely employed to operate on the tributary without harming the sapphenous vein When retracted into the cannulathe retractor is again resiliently straightened or flattened. In an alternate Varizen tubal as illustrated in FIGS. In a first position, the sliding tube is retracted and the retractor protrudes from the distal end at an angle with respect Varizen tubal the central axis of the cannula In a Varizen tubal position, Varizen tubal sliding tube is extended out, temporarily straightening the retractor As illustrated in FIG.

The proximal end of the sliding tube is linked to button for translationally moving retractor as well as actuating the sliding tube In one embodiment, as illustrated in FIG. A spring is coupled between a support structure and the proximal end of the sliding tube In the first position of sliding tubethe spring is extended fully and exerts little or no force on the sliding tube Of course, sliding tube may be manually manipulated without linkage to a button To extend the sliding tubebutton is pushed down, Varizen tubal.

The sliding tube is pushed forward, overcoming the resilient force of springVarizen tubal, to encase Varizen tubal retractor and decrease angle between the distal end of the retractor and the central axis of the cannula Upon releasing the buttonthe spring force Varizen tubal the proximal end of the sliding tube back toward the first position against button The sliding tube is formed of material having sufficient strength to force the retractor to straighten out the angleand the retractor is formed of resilient material having a sufficient flexibility to straighten out the angle in response to a tube being slid over the retractorbut having sufficient rigidity to cradle and dissect a target vessel.

Resiliency of the Varizen tubal ensures return to the downwardly-curved shape after being released from Krampf Fuß Thus, Varizen tubal, in accordance with this embodiment, a user may employ the curved retractor for certain applications and employ the straightened form for other applications.

A manual actuator may be configured in other ways than button to extend the sliding tube in response, Varizen tubal, for example, to being pulled up instead of pushed down, Varizen tubal. Another embodiment employs a retractor which has a naturally straight shape. As illustrated in FIGS. The angling device may be positioned within the same lumens as the retractor and preferably may comprise two wires coupled to points below the cradle of Varizen tubal retractor substantially in parallel positions on each of the legs Upon extending the retractor using buttonthe angling device is extended with the retractor The angling device is coupled to a handle at the proximal end of the cannula to facilitate establishing an angle in the retractor by pulling with a backward force on the angling device


Varizen tubal

This application is a continuation application of copending application Ser. This invention relates to a cannula used for vessel retraction, and more particularly to a cannula and method that includes an endoscopic retractor for vessel ligation, Varizen tubal. Certain cannulas have surgical tools located within the cannula for performing surgical operations on a vessel of interest.

The Varizen tubal is inserted into a surgical site with the distal end of the cannula positioned near the vessel of interest. An endoscope positioned within the cannula allows the surgeon to view the target Varizen tubal, and allows the surgeon to position the surgical tool correctly.

One common procedure is to ligate a vessel or other tissue by tightening a suture loop tied as a slipknot on the vessel before transection to provide hemostasis to the vessel. However, surgeons encounter several difficulties in ligation procedures, Varizen tubal. In one ligation procedure, a second incision must be made at the opposite end of the vessel of interest to ligate and transect the Varizen tubal. Multiple incisions are invasive and should be minimized if possible.

In order to avoid this second incision, some conventional methods require tying a suture loop around the vessel, and pushing the loop along the vessel with a knot pusher until the opposite end is reached. Then, the loop is tightened to provide ligation. However, this procedure is difficult because the slipknot often catches on stumps of cut tributaries or other tissue, Varizen tubal then constricts around the vessel at the wrong position. Also, Varizen tubal, there is no easy method for transecting the vessel after the suture loop is tied to the vessel without potentially prematurely severing the suture.

Thus, a device and method is needed to allow remote, one-incision, Varizen tubal, ligation of a vessel which allows a suture loop to be moved reliably to the site of interest, and ensures that the transection instrument is able to transect the vessel, Varizen tubal, and cut the suture. In accordance with the present invention, a retractor is positioned within a cannula with a dissection cradle end of the retractor positioned at the distal Behandlung von venösen Geschwüren Füße Drogen of the cannula.

The retractor includes a first portion that has an axis approximately parallel to a central axis of the cannula, and a second portion that Thrombophlebitis Hämorrhoiden Venen an axis which is at an angle with respect to the central axis of the cannula.

The dissection cradle is located at the distal end of the second portion of the retractor. In another embodiment, the retractor includes two legs having substantially parallel axes that selectively protrude from the distal end of the cannula. The protruding legs support the dissection cradle formed in the shape of a loop that is positioned in a plane skewed relative to the axes of the legs, with a bottom of the loop directed away from the cannula.

Thus, in operation, when the surgeon locates a vein and side branch of interest, the surgeon extends the retractor to cradle the vein in the dissection cradle. Once cradled, the retractor may be fully extended, Varizen tubal, pulling the vein away from the axis of the cannula, causing the side branch to be isolated and Varizen tubal to a surgical tool.

The surgical tool may then be extended from within the cannula to operate on the isolated and exposed side branch. In another embodiment, the top of the loop of the dissection cradle is flat and thin, allowing atraumatic support of the vein, Varizen tubal, and minimizing contact between the retractor and the surgical tool.

In yet a further embodiment, Varizen tubal, the retractor includes a single leg with the loop formed by the one leg of the retractor, Varizen tubal, and with a stopper coupled to the distal end of the retractor, Varizen tubal. In still another embodiment, Varizen tubal, the cannula comprises a sliding tube which encases the retractor, and in a first position is extended out to encase the second portion of the retractor, and in a second position is bodyaga Varizen to encase only the first portion of the retractor.

In response to being in the first position, the second and first Käse Krampf Beinen of the retractor are Varizen tubal approximately parallel to the axis of the Varizen tubal. In the second position, Varizen tubal, the second portion of the retractor is skewed relative to the axis Varizen tubal the cannula.

In accordance with an alternate embodiment of the present invention, a retractor is positioned within Varizen tubal cannula with a dissection cradle end of the retractor positioned at the distal end of Varizen tubal cannula, Varizen tubal.

The dissection cradle comprises a shoulder part and a curved channel part. Suture forming a suture loop is threaded through a hole in a tension mount that is fixed to the distal end of the cannula and is abutted against the distal end of the shoulder. Upon advancement to the surgical Varizen tubal of interest, the suture loop is safely maintained Varizen tubal place due to the tension provided by the tension mount and the support provided by the shoulder.

The curved channel provides a groove in which the vessel of interest may be cradled. Upon retraction of the retractor, the suture loop is displaced onto the Varizen tubal at the desired position for ligation.

In one embodiment, the loop is tightened by detaching the proximal end of the suture from the cannula and pulling on the suture, constricting the suture loop. In an alternate embodiment, a manual controller for retracting Varizen tubal retractor is attached to the proximal end of the suture.

Upon slidable retraction of the Varizen tubal controller, the retractor is retracted, Varizen tubal, the loop is displaced onto the vessel, and the loop is tightened. In a further embodiment, a transecting device is positioned within the cannula. The distal end of the tension mount is positioned to allow the distal end to be proximal to the shoulder of the dissection cradle responsive to the shoulder being in an axial position relative to the tension mount, Varizen tubal.

This results in the suture and vessel being reliably positioned within reach of the transecting device for transection of the vessel and cutting of the suture. Finally, in a preferred embodiment, the retractor has a distal end having an axis skewed relative to the central axis of the cannula, thus facilitating accurate positioning of the vessel and suture for transection and cutting, and ensuring the proper displacement of the suture loop onto the vessel in response to the retraction of the retractor, Varizen tubal.

The proximal end of the cannula is disposed in handle that includes a button which is coupled to retractor for controlling the translational movement of retractoras described in more detail below, Varizen tubal. The distal end of the cannula houses a retractorand optionally an endoscope and a surgical tooldescribed below. In one embodiment, retractor is formed of resilient wire which has a smooth bend intermediate to a first portion and a second portion of the retractor. The retractor is described as having two portions for ease of description, Varizen tubal, although the retractor may be formed as an integrated structure.

However, Varizen tubal, retractor may also be manufactured from two separate portionsthat are coupled together. The first portion of the retractor is Varizen tubal within the cannula with the axis of the first portion approximately parallel to the axis of the cannula The second portion is positioned to bend away from the central axis of the cannula.

The angle of displacement between the axis of the second portion and the central axis of cannula may be any angle from zero to degrees, Varizen tubal. The second portion includes a dissection cradle at the distal end of the second portion The retractor may be formed of bioinert material such as stainless steel, or a polymer such as nylon or polyetherimide, or other appropriately strong and springy plastic.

In one embodiment, Varizen tubal, the retractor includes a coating for lubrication, insulation, Varizen tubal, and low visual glare using, Varizen tubal, for example, parylene or nylon The top portion of the U-shaped bend is preferably flattened to provide additional surface area for atraumatically supporting a vein or vessel of interest.

The side Varizen tubal of the dissection cradle are used for skeletonizing or dissecting the vein from the surrounding tissues, as well as acting as walls to keep the vessel captured within the arch.

The several embodiments of dissection cradle Varizen tubal described in more detail below. The vein is positioned within the side arches of the cradle The dissection cradle may be used Varizen tubal cradle a vein, vessel, tissue or organ of interest, and surgical tool may be any surgical tool suitable for performing a surgical procedure near the dissection cradle In this embodiment, cradle preferably overlays the endoscope with sufficient clearance to facilitate relative movements thereof.

However, the endoscope may also be located adjacent the surgical tool In one embodiment, endoscope is positioned with cannula to allow a clear field of view upon extension of the retractor Surgical tool is illustrated as scissors, used to sever a tributary or side branch of a saphenous vein In this embodiment, surgical tool is maximally displaced from the cradle at the cannula end More specifically, as shown in FIG.

This ensures that a vein or other tissue of interest Varizen tubal retracted away from the surgical tool to facilitate manipulating the surgical tool relative to the side branch Varizen tubal other tissue.

The retractor is slidably positioned within minor lumens along the length of the cannula within close tolerances in order to position the Varizen tubal stably within the cannula For example, in one embodiment retractor legsare approximately 0. This configuration restricts rotational movement of the retractor to provide more Varizen tubal retraction as compared with conventional retractors. The legsof the retractor are formed of flexible, resilient material and are retained within the lumen in substantially straight or flat orientation, but may return to a material bend or curve, as illustrated in FIG.

The leg of the retractor passes through a sliding gas or fluid seal at the proximal Varizen tubal of the lumen The leg of the retractor passes out of the cannula and into handle for attachment to a slider button for facilitating translational movement of the retractor from the proximal or handle end of the cannula However, other types of control devices such as knobs, grips, Varizen tubal, finger pads, Varizen tubal, and the like may be linked in conventional ways to the retractor in order to manually control the translational movement of retractor In one configuration, the proximal end of leg is bent relative to the axis of the cannula, Varizen tubal, and the button is attached to the bent position of the leg to facilitate moving the button and the retractor Varizen tubal under manual control.

The button preferably includes lateral grooves to prevent finger or thumb slippage during sliding manipulation of the retractor Thus, Varizen tubal, in the operation of a preferred embodiment, a user actuates the slider button to extend retractor out of the lumen at the distal end of the cannula In one embodiment, the resilient retractor is formed in a smooth bend, as shown in FIG.

Upon encountering the target vessel or tissue of interest, the vessel is restrained in the cradleVarizen tubal, and a lateral resilient force is exerted on the target vessel in a direction away from the cannula. The vessel is thus pushed away from the axis of the cannulaVarizen tubal, isolating it from surrounding tissue or adjacent vessels such as tributaries or side branches. As a tributary is thus isolated, a surgical tool such as cauterizing scissors may be safely employed to operate on the tributary without harming the saphenous vein When retracted into the cannulathe retractor is again resiliently straightened or flattened.

In an alternate embodiment as illustrated in FIGS. In a first position, the sliding tube is retracted and the retractor protrudes from the distal end at an angle with respect to the central axis of the cannula In a second position, the sliding tube is extended out, temporarily straightening the retractor As illustrated in FIG. The proximal end of the sliding tube is linked to button for translationally moving retractor as well as actuating the sliding tube In one embodiment, as illustrated in FIG.

A spring is coupled between a support structure and the proximal end of the sliding tube In the first position of sliding tubeVarizen tubal, the spring is extended fully and exerts little or no force on the sliding tube Of course, sliding tube may be manually manipulated without linkage to a button To extend the sliding tubeVarizen tubal, Varizen tubal is pushed down.

The sliding tube is pushed forward, Varizen tubal, overcoming the resilient force of springto encase the retractor and decrease angle between the distal end of Varizen tubal retractor and the central Varizen tubal of the cannula Upon releasing the buttonthe spring force urges the proximal end of the sliding tube back toward the first Varizen tubal against button The sliding tube is formed of material having sufficient strength to force the retractor to straighten out the angleand the retractor is formed of resilient material having a sufficient flexibility to straighten out the angle in response to a tube being slid over the retractorbut having Varizen tubal rigidity to cradle and dissect a target vessel.

Resiliency of the retractor ensures return to the downwardly-curved shape after being released from tube Thus, in accordance with this embodiment, a user may employ the curved retractor for certain applications and employ the straightened form for other applications.

A manual actuator may be configured in other ways than button to extend the sliding tube in response, for example, to being pulled up instead of pushed down. Another embodiment employs a retractor which has a naturally straight shape. Varizen tubal illustrated in Zwiebeln mit trophischen Geschwüren. The angling device may be positioned within the same lumens as the retractor and preferably may comprise two wires coupled to points below the cradle of the retractor substantially in parallel positions Varizen und Behinderung each of the legs Varizen tubal, Upon extending the retractor using buttonthe Varizen tubal device is extended with the retractor The angling device is coupled to a handle at the proximal end of the cannula to facilitate establishing an angle in the retractor by pulling with a backward force on the angling device


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